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Blood Eosinophils t...
Blood Eosinophils to Direct Corticosteroid Treatment of Exacerbations of Chronic Obstructive Pulmonary Disease A Randomized Placebo-Controlled Trial
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Bafadhel, Mona (author)
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McKenna, Susan (author)
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Terry, Sarah (author)
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Mistry, Vijay (author)
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Pancholi, Mitesh (author)
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- Venge, Per (author)
- Uppsala universitet,Biokemisk struktur och funktion
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Lomas, David A. (author)
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Barer, Michael R. (author)
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Johnston, Sebastian L. (author)
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Pavord, Ian D. (author)
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Brightling, Christopher E. (author)
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(creator_code:org_t)
- 2012
- 2012
- English.
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In: American Journal of Respiratory and Critical Care Medicine. - 1073-449X .- 1535-4970. ; 186:1, s. 48-55
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- Rationale: Exacerbations of chronic obstructive pulmonary disease (COPD) and responses to treatment are heterogeneous. Objectives: Investigate the usefulness of blood eosinophils to direct corticosteroid therapy during exacerbations. Methods: Subjects with COPD exacerbations were entered into a randomized biomarker-directed double-blind corticosteroid versus standard therapy study. Subjects in the standard arm received prednisolone for 2 weeks, whereas in the biomarker-directed arm, prednisolone or matching placebo was given according to the blood eosinophil count biomarker. Both study groups received antibiotics. Blood eosinophils were measured in the biomarker-directed and standard therapy arms to define biomarker-positive and -negative exacerbations (blood eosinophil count > and <= 2%, respectively). The primary outcome was to determine noninferiority in health status using the chronic respiratory questionnaire (CRQ) and in the proportion of exacerbations associated with a treatment failure between subjects allocated to the biomarker-directed and standard therapy arms. Measurements and Main Results: There were 86 and 80 exacerbations in the biomarker-directed and standard treatment groups, respectively. In the biomarker-directed group, 49% of the exacerbations were not treated with prednisolone. CRQ improvement after treatment in the standard and biomarker-directed therapy groups was similar (0.8 vs. 1.1; mean difference, 0.3; 95% confidence interval, 0.0-0.6; P = 0.05). There was a greater improvement in CRQ in biomarker-negative exacerbations given placebo compared with those given prednisolone (mean difference, 0.45; 95% confidence interval, 0.01-0.90; P = 0.04). In biomarker-negative exacerbations, treatment failures occurred in 15% given prednisolone and 2% of those given placebo (P = 0.04). Conclusions: The peripheral blood eosinophil count is a promising biomarker to direct corticosteroid therapy during COPD exacerbations, but larger studies are required.
Keyword
- chronic obstructive pulmonary disease
- exacerbations
- prednisolone
- infection
- eosinophils
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Bafadhel, Mona
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McKenna, Susan
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Terry, Sarah
-
Mistry, Vijay
-
Pancholi, Mitesh
-
Venge, Per
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show more...
-
Lomas, David A.
-
Barer, Michael R ...
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Johnston, Sebast ...
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Pavord, Ian D.
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Brightling, Chri ...
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show less...
- Articles in the publication
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American Journal ...
- By the university
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Uppsala University